The Role of Mother’s Prenatal Substance Use Disorder and Early Parenting on Child School-Age Attachment and Social Cognition

Introduction
Maternal substance use disorder (SUD) during pregnancy indicates severe, cumulative bio-psychosocial risks for child development (Conners et al., 2004). Parenting quality may be an important protective factor for children with substance-exposure (Eiden, 2016). Earlier studies on socioemotional outcomes of these children have concentrated on mental health and substance use problems. Deficits in social cognition as well as traumatic attachment histories may underlie these two risks (Bora & Zorlu, 2016, Venta et al. 2017); however, no previous studies have examined them or their developmental antecedents in school-age children of SUD mothers. This study examines, first, whether children of mothers with prenatal SUD differ from controls in attachment and social cognition (mentalization and facial emotion recognition) at school-age. Second, it examines whether good early parenting has protective effect on child attachment and social cognition.

Methods
The original sample comprised 51 pregnant poly-drug-using mothers participating in outpatient interventions, and 50 non-using controls with medical pregnancy risks. At the child age of 8-12 years, families were re-contacted and 39% (n=20) of the SUD group (6 children with a foster mother) and 61% (n=31) of the control group participated. Mother-infant interaction quality was measured at 4 and 12 months with EA scales 4th edition (Biringen, 2008). At school-age, child mentalization was measured with LEAS-C (Bajgar & Lane, 2004), facial emotion recognition with DANVA (Nowicki & Carton, 1993) and attachment with Attachment Story Stem for school-age (Granot & Mayseless, 2001; Kerns et al., 2011).

Results
SUD group children had a higher incidence of insecure (90% vs. 51.5%, χ2(1)=8.06, p = .005) and disorganized (45% vs.13%, χ2(1)= 6.59, p =.01) attachment and more problems in fear recognition, F(1, 46) = 4.72, p = .035) and other-related mentalization, F(1, 46) = 4.04, p = .050. Higher maternal EA predicted better overall emotion recognition accuracy, F (2, 44) = 6.43, p = .004, and recognition of fear and sadness despite group status, but had no protective effect on attachment or mentalization.

Conclusions

Children of mothers with prenatal SUD are at high developmental risk at school-age despite early parenting interventions. Both neurobiological exposure and psychosocial risks adjacent in rearing environment may explain the risks for attachment and social cognition. However, early parenting seems protective for basic processes of emotion recognition, suggesting that these may be more easily modified by early environmental factors and interventions. Long-term interventions targeting parenting and child socioemotional development are still warranted at school-age for this high-risk group.